中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2014年
7期
537-541
,共5页
曹玮%宋晓璟%李雁凌%邱志峰%谢静%韩扬%吕玮%王焕玲%范洪伟
曹瑋%宋曉璟%李雁凌%邱誌峰%謝靜%韓颺%呂瑋%王煥玲%範洪偉
조위%송효경%리안릉%구지봉%사정%한양%려위%왕환령%범홍위
HIV%获得性免疫缺陷综合征%艾滋病相关机会致病菌感染
HIV%穫得性免疫缺陷綜閤徵%艾滋病相關機會緻病菌感染
HIV%획득성면역결함종합정%애자병상관궤회치병균감염
HIV%Acquired immunodeficiency syndrome%AIDS-related opportunistic infections
目的 总结综合医院首次确诊HIV/AIDS患者的临床特征,以提高临床医生对HIV/AIDS患者的早期识别和诊断水平.方法 回顾性分析北京协和医院首次确诊并有完整病历资料的297例HIV/AIDS患者,包括急性期19例、无症状期115例、AIDS期163例,对其临床特征、诊断途径及机会性感染谱进行分析.结果 219例患者出现临床症状.常见全身症状包括发热(100例,33.7％)、消瘦(50例,16.8％)、乏力(38例,12.8％);脏器受累症状包括皮肤黏膜损害(67例,22.6％)、呼吸系统症状(62例,20.9％)、消化系统症状(40例,13.5％)等,AIDS期患者脏器受累症状更突出.42.2％(73/173)的患者确诊前就诊2次以上,确诊科室主要为感染科(36.9％)、消化科(16.4％)、急诊科(13.7％)等.AIDS指向性疾病(AIDS defining conditions,ADC)以机会性感染为主,包括耶氏肺孢子菌肺炎(36例,22.1％)、巨细胞病毒感染(25例,15.3％)、结核分枝杆菌感染(22例,13.5％);合并ADC者CD4 T淋巴细胞中位数为36个/μl.结论 发热、消瘦、腹泻、气短和皮肤黏膜损害是HIV/AIDS最常见的临床表现.机会性感染常见于呼吸系统、皮肤黏膜及消化系统.HIV/AIDS诊断普遍偏晚,临床诊断需要各专科共同应对.
目的 總結綜閤醫院首次確診HIV/AIDS患者的臨床特徵,以提高臨床醫生對HIV/AIDS患者的早期識彆和診斷水平.方法 迴顧性分析北京協和醫院首次確診併有完整病歷資料的297例HIV/AIDS患者,包括急性期19例、無癥狀期115例、AIDS期163例,對其臨床特徵、診斷途徑及機會性感染譜進行分析.結果 219例患者齣現臨床癥狀.常見全身癥狀包括髮熱(100例,33.7％)、消瘦(50例,16.8％)、乏力(38例,12.8％);髒器受纍癥狀包括皮膚黏膜損害(67例,22.6％)、呼吸繫統癥狀(62例,20.9％)、消化繫統癥狀(40例,13.5％)等,AIDS期患者髒器受纍癥狀更突齣.42.2％(73/173)的患者確診前就診2次以上,確診科室主要為感染科(36.9％)、消化科(16.4％)、急診科(13.7％)等.AIDS指嚮性疾病(AIDS defining conditions,ADC)以機會性感染為主,包括耶氏肺孢子菌肺炎(36例,22.1％)、巨細胞病毒感染(25例,15.3％)、結覈分枝桿菌感染(22例,13.5％);閤併ADC者CD4 T淋巴細胞中位數為36箇/μl.結論 髮熱、消瘦、腹瀉、氣短和皮膚黏膜損害是HIV/AIDS最常見的臨床錶現.機會性感染常見于呼吸繫統、皮膚黏膜及消化繫統.HIV/AIDS診斷普遍偏晚,臨床診斷需要各專科共同應對.
목적 총결종합의원수차학진HIV/AIDS환자적림상특정,이제고림상의생대HIV/AIDS환자적조기식별화진단수평.방법 회고성분석북경협화의원수차학진병유완정병력자료적297례HIV/AIDS환자,포괄급성기19례、무증상기115례、AIDS기163례,대기림상특정、진단도경급궤회성감염보진행분석.결과 219례환자출현림상증상.상견전신증상포괄발열(100례,33.7％)、소수(50례,16.8％)、핍력(38례,12.8％);장기수루증상포괄피부점막손해(67례,22.6％)、호흡계통증상(62례,20.9％)、소화계통증상(40례,13.5％)등,AIDS기환자장기수루증상경돌출.42.2％(73/173)적환자학진전취진2차이상,학진과실주요위감염과(36.9％)、소화과(16.4％)、급진과(13.7％)등.AIDS지향성질병(AIDS defining conditions,ADC)이궤회성감염위주,포괄야씨폐포자균폐염(36례,22.1％)、거세포병독감염(25례,15.3％)、결핵분지간균감염(22례,13.5％);합병ADC자CD4 T림파세포중위수위36개/μl.결론 발열、소수、복사、기단화피부점막손해시HIV/AIDS최상견적림상표현.궤회성감염상견우호흡계통、피부점막급소화계통.HIV/AIDS진단보편편만,림상진단수요각전과공동응대.
Objective To determine the clinical characteristics of HIV infected patients in China in order to improve early recognition and diagnosis of AIDS.Methods A total of 297 newly diagnosed HIV/ AIDS patients were enrolled in Peking Union Medical College Hospital (PUMCH) from January 2001 to December 2012,including 19 patients of primary phase,115 of asymptomatic phase and 163 of AIDS phase.Clinical characteristics of these patients were retrospectively analyzed.Results Two hundred and nineteen out of 297 patients reported clinical symptoms with variety.The main systemic symptoms included fever (100 cases,33.7％),weight loss (50 cases,16.8％) and fatigue (38 cases,12.8％).Organ involvement included mucocutaneous (67 cases,22.6％),respiratory (62 cases,20.9％),gastrointestinal (40 cases,13.5％) systems.Patients in AIDS phase were more symptomatic.Seventy-three out of 173 (42.2％) patients have been referred by 2 healthcare providers at least before the diagnosis of HIV infection was confirmed.Initial diagnoses were made in Departments of Infectious Diseases (36.9％),Gastroenterology (16.4％),and Emergency (13.7％).Opportunistic infections accounted for most AIDS defining conditions (ADC),including pneumocystis jiroveci pneumonia (PCP) (36 cases,22.1％),cytomegalovirus infection (25 cases,15.3％) and tuberculosis (22 cases,13.5％).Median peripheral CD4+ T lymphocyte count in patients with ADC were 36 cells/μl.Conclusions Common clinical presentations of HIV/AIDS included fever,weight loss,diarrhea,short of breath and mucocutaneous lesions.Opportunistic infections mainly affected respiratory and gastrointestinal system,with PCP the most common one.The diagnosis of HIV infection was delayed in most cases,suggesting that more efforts are required especially in universal education of clinicians and accurate viral detection.
